Topical Glycosaminoglycan Lotion and Microneedling Therapy for Androgenetic Alopecia

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Sir, Microneedling (MN) is a minimally invasive procedure, in which small incisions are made in the patient’s scalp with the aim of enhancing hair growth through molecular stimulation resulting from tissue repair.[1,2] In addition, these microtunnels can be used to increase the percutaneous absorption of topical products.[3] Glycosaminoglycans (GAGs) are mucopolysaccharides involved in the homeostatic maintenance of the skin, and wound repair and have been used as an ex vivo medium to promote hair follicle growth.[4] The objective of this study was to evaluate the effectiveness and safety of the combination of a topical GAG lotion and MN in patients with androgenetic alopecia (AGA). Sixteen patients with a diagnosis of AGA were recruited for this prospective analytical study. Exclusion criteria were age <18 years, pregnancy, and use of any topical or systemic medication in the past 24 weeks. The study was approved by the Local Ethics Committee (approval number: 452/20), and participants signed informed consent before the initiation of study procedures. All the patients were subjected to four sessions of MN and the topical application after each session of a purified lotion based on WGC technology ® (Histocell, Spain) containing GAGs (CAS number 94945-04-7) and the following excipients: sodium chloride, sodium (dihydrogen) phosphate, disodium phosphate, and water. Sessions were held every 4 weeks. MN procedure was performed with sterile 1.5 mm needles on the frontal, interparietal and vertex scalp aiming for pinpoint bleeding without the aid of anesthesia. Trichoscopic evaluation of follicular thickness and hair density was performed in a 1 cm2 area of the scalp located 12 cm from the glabella with the TrichoLAB software (FotoFinder Systems GmbH, Germany). Eight (50%) of the patients were women; (75%) 6 suffered from female pattern hair loss Grade I of Ludwig and the remaining 25% Grade II. The mean age of the patients was 42.2 years (range 36–62). In the case of men, 37.5%[3] suffered from male-pattern hair loss Grade II of Hamilton-Norwood, 50% from Grade III[4] and 1 patient from Grade IV, with a mean age of 35.6 years (22–61 years). The treatment globally increased hair density (P = 0.02) and thickness (P = 0.02) after a 10-month follow-up [Table 1]. Standardized clinical photographs showed mild improvement of two patients (12.5%) and no improvement of the rest of the patients at the end of the study [Figure 1 and Supplementary Figures 1-4]. Patient Global Assessment of hair loss improvement was evaluated by the study participants as a great improvement in one case, moderate improvement in seven cases (43.75%), mild improvement in five cases (31.25%), and no improvement in the remaining 3 (18.75%) patients. No adverse effects except pain were observed. A Visual Analog Scale for pain of the procedure (from 0: no pain to 10: maximum pain) was evaluated by the patients and resulted in a 2.7 score (range 1–6). MN is considered an adjuvant emergent hair loss treatment given its ability to stimulate the cellular Wnt/β-catenin pathway (responsible for anagen phase signaling) and improve dermal papillae stem cell proliferation.[2,5] Although its direct effectiveness is limited compared to oral treatment, MN allows transdermal drug delivery of topical agents. This study shows that MN treatment associated with transdermal delivery of a GAG hydrogel matrix increases hair density and follicular thickness in AGA patients; this effect could be synergic. Due to the action mechanism of this treatment, systemic adverse effects are improbable. This combination could be useful as a stand-alone therapy in selected patients with mild AGA or as an adjunct treatment with oral medication. Although the low number of patients in this study due to the strict inclusion criteria could be considered a limitation, it also raises the internal validity of the results. Further studies should pursue this line of investigation.Table 1: Hair density and follicular thickness changes after treatmentFigure 1: Male patient with mild improvement in hair density at the end of treatment. Note the reduction in the width of the interparietal hairline as a result of the increase in follicular thickness. (a) Before treatment. (b) After 4 months of treatmentSupplementary Figure 1: Stability of female pattern androgenetic alopecia after 10 months of treatmentSupplementary Figure 2: Mild improvement of female pattern androgenetic alopecia after 10 months of treatmentSupplementary Figure 3: Stability of female pattern androgenetic alopecia after 10 months of treatmentSupplementary Figure 4: Trichoscopic images before and after treatment of Figure 1 patientFinancial support and sponsorship This study has been funded by Cantabria Labs. Conflicts of interest P. Fernandez-Gonzalez has worked in the past as scientific advisor to Cantabria Labs. The rest of the authors have no conflict of interest.

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